Will North Carolina Try a New Medicaid Expansion Model?

Medicaid expansion is back, but this time from four Republicans in the North Carolina House. Earlier this month, lawmakers filed a measure that would extend health coverage to more people, but not under the traditional expansion model that many states and D.C. have followed under the Affordable Care Act (ACA).

For North Carolina and other states that haven’t signed on to Medicaid expansion under the option offered by the ACA, key concerns have been the vastly higher enrollment—and state costs—than anticipated in other states, as well as skepticism that the U.S. government would keep its promise to pay for the majority of costs.

The N.C. House bill would implement a program called Carolina Cares, in which program enrollees would be charged premiums and would be subject to work requirements. Those earning incomes at or below 133 percent of the federal poverty level (less than $16,000 for an individual) would pay annual premiums costing 2 percent of their household income and would have to be working or actively working toward employment.

In order to be implemented, this program would have to obtain federal approval since it includes work requirements and premium payments.